DIANA ELIZABETH GWINN (NPI# 1386122687) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1386122687 |
Entity Type | Individual |
Full Name | DIANA ELIZABETH GWINN |
Credential | DD1 |
Practice Address |
16405 Ne Fargo Cir Portland OR 97230-5513 |
Practice Telephone | 5034847287 |
Practice Fax Number | 5032105974 |
Mailing Telephone | 5034847287 |
Mailing Fax Number | 5032105974 |
Enumeration Date | 2018-07-30 |
Last Update Date | 2018-07-30 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
10465 | OR | Nursing & Custodial Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
OR | 500745787 | 05 |
Street Address |
16405 NE FARGO CIR |
City | PORTLAND |
State | OR |
Zip Code | 97230-5513 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1932687233 | Timisha K Wilson | Social Worker | 12505 Ne Halsey St, Portland, OR 97230 | 2018-07-30 |
1356828768 | Sally Gail Logan | Pharmacist | 5725 Ne 138th Avenue, Portland, OR 97230 | 2018-07-27 |
1063937951 | Marley Elizabeth Small | Counselor | 1507 Ne 122nd Ave., Portland, OR 97230 | 2017-08-11 |
1447771316 | Shadab Nasreen Aijazi | Pathology | 5220 Ne 122nd Avenue, Portland, OR 97230 | 2017-06-30 |
1104378199 | Derek Andrus | Pharmacist | 5717 Nw 138th, Portland, OR 97230 | 2016-10-26 |
1164972675 | Rachael Anderson | Adult Companion | 423 Ne 160th Ave #11, Portland, OR 97230 | 2016-10-07 |
1750837597 | Providence Elderplace | Assisted Living Facility | 16430 Ne Hoyt St, Portland, OR 97230 | 2016-08-31 |
1649622473 | Sara Mcgroarty | Counselor | 17710 Ne Halsey Street, Portland, OR 97230 | 2016-07-05 |
1346699949 | Steven D Stanton | Counselor | 1022 Ne 181st Ave, C1, Portland, OR 97230 | 2016-06-06 |
1215390091 | The Wallace Medical Concern | Clinic/Center | 18139 Ne Couch Street, Portland, OR 97230 | 2016-03-30 |
Find all providers in zip 97230 |
Taxonomy Code | 311ZA0620X |
Grouping | Nursing & Custodial Care Facilities |
Classification | Custodial Care Facility |
Specialization | Adult Care Home |
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1801403910 | Baseti Gelgelu | Custodial Care Facility | 2055 Sw 79th Ave, Portland, OR 97225-3805 | 2020-09-23 |
1801402946 | Demeti Gelgelu | Custodial Care Facility | 2010 Sw 79th Ave, Portland, OR 97225-3806 | 2020-09-22 |
1306212295 | Amer Filipovic | Custodial Care Facility | 2708 Se 111th Ave, Portland, OR 97266-1106 | 2015-08-14 |
1740410356 | Paradise Adult Foster Care Incorporated | Custodial Care Facility | 1356 Se 172nd Ave, Portland, OR 97233-4702 | 2009-07-16 |
1013153659 | Ileana Kerezsi | Custodial Care Facility | 3519 Se Cora Dr, Portland, OR 97202-3332 | 2009-01-04 |
1639291131 | Casa, Inc | Custodial Care Facility | 741 Warren Ave, Portland, ME 04103-1007 | 2007-04-04 |
1295043982 | Lifeworks Northwest | Custodial Care Facility | 14600 Nw Cornell Rd, Portland, OR 97229-5442 | 2010-09-16 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1447808100 | Remelita Loftin | Custodial Care Facility | 2297 Minnesota St, Eugene, OR 97402-6244 | 2019-08-27 |
1316506397 | Stephenie Jo Murdock | Custodial Care Facility | 2355 Baker St, Baker City, OR 97814-2541 | 2019-06-12 |
1346707296 | Dastu I Ahmat | Custodial Care Facility | 55 Nw 23rd St, Gresham, OR 97030-2640 | 2019-02-27 |
1558837781 | Larisa Kravchuk | Custodial Care Facility | 805 Fir Cone Dr Ne, Keizer, OR 97303-4328 | 2018-10-15 |
1376071464 | Mckenzie Living, Incorporated | Custodial Care Facility | 2621 Lone Oak Way, Eugene, OR 97404 | 2017-06-01 |
1598292997 | Gateway Assisted Living, Inc. | Custodial Care Facility | 611 N Cloverleaf Loop, Springfield, OR 97477-1188 | 2017-05-16 |
1841727617 | Gateway Gardens Assisted Living, Inc. | Custodial Care Facility | 178 Commons Dr, Eugene, OR 97401-8923 | 2017-05-11 |
1609314509 | Catherine Jensens Foster Home | Custodial Care Facility | 108 Ash Drive, Rogue River, OR 97537 | 2017-02-10 |
1932647211 | Lynn Marie Bartlett | Custodial Care Facility | 4286 Camellia Dr S, Salem, OR 97302-2710 | 2017-02-07 |
1568906477 | Radiant Care Afh 'llc' | Custodial Care Facility | 52 Nw Birch Ct, Warrenton, OR 97146 | 2016-12-12 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.